Friday, June 14, 2013

RX for states: Expand Medicaid -- June 13, 2013 column

By
MARSHA MERCER

“Americans
can always be counted on to do the right thing – after they have exhausted all other
possibilities,” Winston Churchill supposedly said.

Whether the
remark reflected Churchill’s or someone else’s wit, we again are seeing Americans
struggle over the right thing. This time the right thing is for every state to
expand Medicaid, the joint federal-state health insurance program for the poor.

Medicaid
currently provides health care to about 59 million low-income people – mostly young
children and their parents and pregnant women. It pays for long-term care for
seniors in nursing homes and people with disabilities. Some states, like Massachusetts,
expanded Medicaid coverage on their own.

In March
2010, President Barack Obama signed the Affordable Care Act – a.k.a. Obamacare
– which aims to bring affordable health care to most Americans no matter where
they live.

The law
is making significant changes. Next year, insurance companies can no longer
discriminate against people with pre-existing health conditions, and almost
every American will have to have health insurance or pay a tax penalty. The law
also required every state to expand Medicaid to cover people with incomes up to
133 percent of the federal poverty level, about $26,000 for a family of three
in 2013. The Congressional Budget Office said the Medicaid expansion would provide
16 million Americans with reliable health care.

Republican
state officials challenged the law in the courts. Last June, the Supreme Court
upheld the law but said expanding Medicaid was a state option. Today 22 states
and the District of Columbia are moving forward with the Medicaid expansion,
according to the Kaiser Family Foundation. These include California, Minnesota,
New Jersey and New York.

About 20
states have rejected the expansion – at least for now. Among them are Alabama,
Florida, North Carolina, Oklahoma, Texas and Virginia. Eight other states
around the country are still fighting it out.

In five Deep
South states that have opted out – Alabama, Georgia, Mississippi, Louisiana and
South Carolina – 62 percent of residents support the Medicaid expansion, a poll
in March and April by the Joint Center for Political and Economic Studies
found. The center is a public policy research
group that focuses on African Americans.

Virginians
were almost evenly split in March with 45 percent favoring expansion and 43
percent opposed, a Quinnipiac University poll reported.

States
that have rejected the expansion have some of the nation’s worst health records.
America’s Health Rankings, an annual report by United Health Foundation, ranked
Mississippi and Louisiana 49th, -- the
least healthy states. Alabama is 45th and Virginia 21st.

The
states are forgoing “free” money. The federal government will foot 100 percent of Medicaid expansion costs
from 2014 to 2016. Repayment will drop to 90 percent in 2020 and level off after
that. That’s a much better match than states currently have for Medicaid. The
federal share ranges from 50 percent to 83 percent, with poorer states getting
higher amounts per capita.

Critics
of expansion say they worry about unspecified costs down the road, and yet people
without health insurance get health care every day in more costly hospital emergency
rooms.

A new Rand
study of the first 14 states whose governors declared they would not expand
Medicaid, including Alabama, found those states together would spend $1 billion
more on uncompensated health care in 2016 than if they expanded Medicaid. The
14 states would give up $8.4 billion annually in federal payments, Rand said.

An
analysis of state health data by the Los Angeles Times indicates that the
states could use the help. Colon cancer deaths in states that oppose the
Medicaid expansion are, on average, 16 percent higher than in states that
support expansion, and deaths from breast cancer are 8 percent higher on
average in states that oppose the expansion.

“Medicaid by itself may not close those gaps, which also
reflect income and education disparities,” the paper reported, noting that conservatives
argue that poor people would be helped more by alternative strategies that
encourage people to take responsibility for their own health care.

States that don’t expand Medicaid still face other higher
costs. Nationwide, only about two-thirds of people eligible have signed up for Medicaid,
and the new health law includes a major outreach effort.

The fight
over Medicaid is far from over. There’s no deadline for expansion, and supporters
say they’ll be back in statehouses for the next legislative session. As they
say in baseball, there’s always next year.

For now,
though, it appears many states are determined to ignore the proverb and be
“penny wise and pound foolish.”